Eating out as a coeliac – when relinquishing control causes complications

For the majority of people, eating out is relaxing, but for coeliacs it can be anxious, frustrating and even illness-inducing. Being diagnosed as coeliac requires a complete review of the larder, to eliminate foods containing gluten, and also a new vigilance when eating outside the home.

With the rise of the gluten-free diet as a lifestyle choice – often promoted by sportspeople and celebrities – there has also been confusion about the distinction between those adhering to the diet as a health choice and coeliacs who are suffering from an auto-immune disease and must avoid gluten as a medical necessity.

Learning to adapt shopping, ingredients and food preparation to ensure adherence to a gluten-free diet, while initially challenging, is manageable with supports like the Coeliac Society of Ireland's annual food list. Once informed and in control of the diet, staying gluten-free and healthy is relatively simple: it is when coeliacs have to relinquish control to others that complications can arise. Considering that eating away from home can include crèches, school canteens, coffee shops, restaurants, pubs, take-aways, deli counters, dinner parties and family occasions, the scale of the challenge is evident.

I never used to eat out because I was afraid of getting sick . . .

For Aoife O’Neill, who blogs as Coeliac Girl Cork, her initial diagnosis made her hesitant to eat out. “I used to just eat at home. I never used to eat out because I was afraid of getting sick because I have a very high intolerance to it (gluten)”, she says.

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However, she gradually overcame her fear via a process of “trial and error” and is now planning a singularly important meal – her wedding reception.

For O'Neill, knowing that she would be catered for as a coeliac on her wedding day was a major influence on her venue choice. "That's part of the reason we picked the Garryvoe Hotel because they are so well equipped for different allergies. They have a separate fryer and a separate part of the kitchen. That was a big thing about having our wedding there. That I'd be fed and I'd be happy."

Andrea Boyle, whose son Pierce was diagnosed as a coeliac in 2017, is similarly cautious about his food as he suffered severe illness prior to his diagnosis. She explains that, "before we go into a restaurant, Alan, my husband, asks from the start, 'do you cater for coeliacs?'"

She has found Pierces’s school, St Gerard’s in Bray,Co Wicklow, very supportive. On diagnosis, their medical officer liaised with the school canteen to ensure that Pierce only ate school food compatible with his condition. Eating out with his friends can be hard, as teenagers love fast food outlets, where gluten is widespread. Eighteen months into life as a coeliac, Andrea says that Pierce is good at maintaining his gluten-free diet: “He learned the hard way for himself.”

Cross-contamination

Since December 2014, allergen labelling information has been mandatory for all non-pre-packed foods in Ireland. Included in the 14 food allergens that must be declared is gluten. While this has been extremely helpful to coeliacs when eating out, it doesn't cover the perils of cross-contamination, which is defined by the Coeliac Society as "the process by which a gluten-free product/food loses that status because it comes in contact with something that is not gluten-free. This can be by way of surface area, cooking medium/method, storage and handling or preparation methods."

Common incidences are when chips are fried in oil that has been used to cook foods covered in batter or when a gluten-free pizza is cooked in the same oven as bases made from wheat. When baking gluten-free breads and cakes it can occur when particles of wheat based flour become airborne and land on food, work surfaces and utensils.

Another issue is when dishes become confused, if the restaurant doesn’t have a system to manage gluten-free orders. O’Neill recalls: “One occasion I went out, me and my fiancé ordered the same food and he ordered his non-gluten free while I got mine coeliac friendly and they swapped the two. They got mixed . . . I got very, very sick.”

Consuming gluten accidentally has serious repercussions for coeliacs, including severe cramping and diarrhoea, nausea, vomiting, acute weakness, lethargy and dehydration. O’Neill admits: “It wipes me out for a few days.”

‘Gluten friendly’ and ‘contains gluten’

Adding to the confusion coeliacs experience around menus is the fact that how restaurants choose to communicate allergy information to customers is not mandated in any one format. So deciphering ingredient lists and/or symbols, numbers, and “gluten friendly” as opposed to “contains gluten” flags can be comparable to solving the enigma code.

Denis O'Riordan, a board member of the Coeliac Society, while admitting that things have become "fantastically better", still sees lots of room for progress so that a "comparable eating experience" for coeliacs becomes standard. He cites his experience in Spain where the "Sin Gluten" sign is prominently displayed in establishments who have undertaken specific training in serving coeliac dietary requirements, as an excellent initiative. The Irish Coeliac Society is working on a comparable industry training scheme. "One of the things we hope to do is to put up the online training tool and make it as cheap as possible for restaurants to actually put their staff through it," O'Riordan says.

Gearóid Lynch, proprietor of The Olde Post Inn in Cavan and a coeliac, is ideally placed to appreciate coeliac dining from the customer’s and the chef’s perspective. While he has suffered accidental gluten ingestion as a customer, he doesn’t identify his business as a “gluten-free restaurant”.

“I think the first thing you have to do as a chef/owner/operator is make sure that your staff are all very well aware of it.”

I think the onus does come back on the guest going into the restaurant

He prefers clients to identify as coeliac clearly, and in advance. “I think the onus does come back on the guest going into the restaurant and then the restaurant or the kitchen, hotel, bar, whatever the case may be, has to do their best to make sure that it is avoided at all costs.”

He cites knowledge in the kitchen and front of house staff, willingness to work and communicate with coeliac customers and organisations, as the best strategy to feed coeliacs safely.

Aileen Markey, the incoming chairperson of the Coeliac Society, would like to see a mindset change in terms of coeliacs and the restaurant industry. She states: "The mindset now in restaurants, whether it's the owners and the staff - it's one of fear. . . They fear it, they're afraid and we need to get past that and instead of saying to a coeliac, as they come in, there's all the things you can't have, focus more on what they can have, so try and turn it into a positive. Fifty thousand people in the country have this disease, we're not all going to stay indoors for the rest of our lives, for fear of getting sick."

DOS AND DON'TS OF EATING OUT FOR COELIACS
– Check before visiting that the establishment caters for coeliacs. While caterers must provide allergen information, they don't have to offer a gluten-free meal.
– Check their website to see if they mention serving coeliacs/gluten-free options.
– Check that they understand that coeliacs don't just have a problem with wheat but also barley, rye, oats, spelt, khorasan wheat and their derivatives.
– Establish that they understand cross-contamination, request that they cook your food separately.
– When travelling, purchase a Coeliac Society Eating Out Card in the language of your destination.
– Request a copy of the Coeliac Friendly Restaurant List which is available to members.
– Politely ask questions about anything you are uncertain of, so the restaurant understands your dietary requirements.
– Explicitly identify as a coeliac, rather than just requesting gluten-free food.
– If you wish to complain about receiving food containing gluten, follow the advice of the Food Safety Authority of Ireland.